aripiprazole for bipolar disorder and alcohol use disorder

Conditions: Bipolar Disorder; Alcoholism; Alcohol Abuse

Summary: the investigators will conduct a 12-week, randomized, double-blind, parallel-group, placebo-controlled study of aripiprazole in 132 persons with alcohol use disorder (aud) and bipolar i or ii disorder, currently depressed or mixed phase. primary aim will be to assess change in alcohol use by the timeline followback (tlfb) method. secondary aim will include change in alcohol craving using the penn alcohol craving scale (pacs). changes in psychiatric symptoms (mania/hypomania and depression) and predictors of response will be assessed. participants with ≥ 1 drinking day at week 12 will be enrolled in a 4-week extension phase with an upward titration to 30 mg/day for those in the active treatment group. the placebo group will remain on placebo. subjects will be discontinued from the study if any of the following conditions occurs: change in diagnosis to other than bipolar i or ii disorder and aud, development of active suicidal or homicidal ideation with plan and intent, worsening in mood symptoms, that in the opinion of the investigators requires discontinuation, pregnancy, development of severe or life-threatening medical condition, involuntary psychiatric hospitalization or incarceration, significant alcohol withdrawal (e.g. delirium tremens) based on clinical judgment (increases in clinical institute withdrawal assessment for alcohol (ciwa-ar) scores will initiate a careful clinical assessment of possible worsening of withdrawal symptoms), or cocaine or amphetamine-positive urine drug screen during the study.


Eligibility criteria:
inclusion criteria: * outpatient men and women age 18-65 years old with bipolar i, ii, not otherwise specified (nos) disorder, or schizoaffective bipolar type * if diagnosed with bipolar i, bipolar nos w/history of mania or schizoaffective disorder bipolar type, current mood stabilizer therapy (lithium, valproic acid, lamotrigine, gabapentin) with stable dose for \> 28 days prior to randomization. * baseline barrett impulsiveness scale-11 score of \> 62 (above average impulsivity) * systolic bp \> 100 and \ 60 and \< 105 with no evidence of orthostatic hypotension * current diagnosis of alcohol use disorder with at least moderate severity * alcohol use of an average of 15 drinks per 7 days in the past 28 days prior to intake for men, and an average of 8 drinks per 7 day period in the past 28 days prior to intake for women * current mood stabilizer therapy with stable dose for \> 28 days * fluent in english or spanish exclusion criteria: * baseline hamilton rating scale for depression (hrsd) or young mania rating scale (ymrs) scores \> 35 * mood disorders other than bipolar i, ii, nos or schizoaffective disorder bipolar type (e.g. cyclothymic disorders, schizophrenia, schizoaffective disorder depressive type, or unipolar depression based on the scid), other disorders, e.g. anxiety disorders, will be allowed. * current diagnosis of amphetamine or cocaine use disorder or a cocaine or amphetamine positive baseline urine sample. * evidence of clinically significant alcohol withdrawal symptoms * current treatment with an atypical antipsychotic * current treatment with naltrexone, acamprosate, disulfiram, or topiramate in the last 28 days * prior treatment with aripiprazole within the last year or lifetime history of intolerable side effects to aripiprazole * vulnerable populations (e.g. pregnant, nursing, cognitively impaired, incarcerated.) * evidence of clinically significant alcohol withdrawal symptoms defined as a ciwa-ar score of ≥ 10. * high risk for suicide * aspartate amino transferase (ast) or alanine amino transferase (alt) \> 3 times upper limit of normal * current use of cytochrome p450 3a4 inducing medication (e.g. carbamazepine, rifabutin, rifampin, ritonavir). * use of other substances (besides cocaine/amphetamine) is allowed if the use disorder is no greater than moderate severity and alcohol is the self-identified substance of choice. * history of neuroleptic malignant syndrome or tardive dyskinesia. more specific inclusion and exclusion criteria will be discussed with participant at baseline assessment.

Keywords: alcohol use disorder bipolar disorder mood alcohol craving aripiprazole schizoaffective disorder